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Neuromonitoring in paediatric anaesthesia

Davidson, Andrewa,b; Skowno, Justinc,d

Current Opinion in Anesthesiology: June 2019 - Volume 32 - Issue 3 - p 370–376
doi: 10.1097/ACO.0000000000000732

Purpose of review There has been a steady advance in neuromonitoring during anaesthesia. Inevitably much of the research is first done in adults and later in children. This review will focus on the recent paediatric publications (2017–2019) in two areas of neuromonitoring – measuring anaesthesia effect and cerebral perfusion and oxygenation.

Recent findings For EEG-derived depth monitors, the main recent advances have been in better understanding their performance in infants. For the first time, large multichannel EEG studies on infants have focused on understanding the basic principles of how anaesthesia impacts on the EEG of the developing brain in a way different to the older brain. Nociception monitors are beginning to be studied in children. In the area of optical neuromonitoring, studies show that cerebral desaturation during both general and spinal anaesthesia in infants is uncommon in neonates and infants. Further work emphasizes the importance of CO2 levels on cerebral oxygenation, and demonstrates impaired cerebral autoregulation in premature infants undergoing laparotomies.

Summary The impact of anaesthesia on the EEG of small infants has some gross similarities to older children but there are fundamental differences, which mandate separate calibration of anaesthesia depth monitors. The role of nociception monitors in children has yet to be defined. Cerebral oxygenation monitoring during paediatric anaesthesia is improving our understanding of cerebral perfusion in this period, but as with almost all monitoring, evidence that its use improves outcome is not yet available.

aDepartment of Anaesthesia, Royal Children's Hospital

bAnaesthesia Research Group, Murdoch Children's Research Institute, Melbourne

cDepartment of Anaesthesia, The Children's Hospital at Westmead

dDiscipline of Child and Adolescent Health, University of Sydney, Sydney, Australia

Correspondence to Andrew Davidson, MBBS, MD, FANZCA, FAHMS, Department of Anaesthesia, Royal Children's Hospital, Flemington Road, Parkville 3052, VIC, Australia. Tel: +61 3 93454008; e-mail:

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